Department of Plastic and Reconstructive Surgery, University Hospitals Cleveland Medical Center-Case Western Reserve University, Cleveland, OH.
Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD.
J Craniofac Surg. 2023 Jun 1;34(4):1199-1202. doi: 10.1097/SCS.0000000000009190. Epub 2023 Jan 30.
Opioid minimization in the acute postoperative phase is timely in the era of the opioid epidemic. The authors hypothesize that patients with facial trauma receiving multimodal, narcotic-minimizing pain management in the perioperative period will consume fewer morphine milligram equivalents (MMEs) while maintaining adequate pain control compared with a traditional analgesia protocol. An IRB-approved pilot study evaluating isolated facial trauma patients compared 10 consecutive prospective patients of a narcotic-minimizing pain protocol beginning in August 2020 with a retrospective, chart-reviewed cohort of 10 consecutive patients before protocol implementation. The protocol was comprised of multimodal nonopioid pharmacotherapy given preoperatively (acetaminophen, celecoxib, and pregabalin). Postoperatively, patients received intravenous (IV) ketorolac, scheduled acetaminophen, ibuprofen, and gabapentin. Oxycodone was reserved for severe uncontrolled pain. The control group had no standardized protocol, though opioids were ad libitum. Consumed MMEs and verbal Numeric Rating Scale (vNRS) pain scores (0-10) were prospectively tracked and compared with retrospective data. Descriptive and inferential statistics were run. At all recorded postoperative intervals, narcotic-minimizing subjects consumed significantly fewer MMEs than controls [0-8 h, 21.5 versus 63.5 ( P = 0.002); 8-16 h, 4.9 versus 20.6 ( P = 0.02); 16-24 h, 3.3 versus 13.9 ( P = 0.03); total 29.5 versus 98.0 ( P = 0.003)]. At all recorded postoperative intervals, narcotic-minimizing subjects reported less pain (vNRS) than controls (0-8 h, 7.7 versus 8.1; 8-16 h, 4.4 versus 8.0; 16-24 h 4.3 versus 6.9); significance was achieved at the 8 to 16-hour time point ( P = 0.006). A multimodal, opioid-sparing analgesia protocol significantly reduces opioid use in perioperative facial trauma management without sacrificing satisfactory pain control for patients.
在阿片类药物流行的时代，急性术后阶段的阿片类药物最小化是及时的。作者假设，在围手术期接受多模式、减少阿片类药物的疼痛管理的面部创伤患者与传统镇痛方案相比，在维持足够疼痛控制的同时，将消耗更少的吗啡毫克当量（MME）。一项经过机构审查委员会批准的试点研究评估了孤立性面部创伤患者，将 2020 年 8 月开始的阿片类药物最小化疼痛方案的 10 名连续前瞻性患者与方案实施前回顾性图表审查的 10 名连续患者进行比较。该方案包括术前给予多模式非阿片类药物治疗（对乙酰氨基酚、塞来昔布和普瑞巴林）。术后，患者接受静脉（IV）酮咯酸、计划给予对乙酰氨基酚、布洛芬和加巴喷丁。羟考酮仅用于严重无法控制的疼痛。对照组没有标准化方案，但阿片类药物可随意使用。前瞻性跟踪并比较了消耗的 MME 和口头数字评分量表（vNRS）疼痛评分（0-10），并进行了描述性和推断性统计分析。在所有记录的术后间隔时间，阿片类药物最小化组消耗的 MME 明显少于对照组[0-8 小时，21.5 与 63.5（P=0.002）；8-16 小时，4.9 与 20.6（P=0.02）；16-24 小时，3.3 与 13.9（P=0.03）；总 29.5 与 98.0（P=0.003）]。在所有记录的术后间隔时间，阿片类药物最小化组报告的疼痛（vNRS）明显少于对照组（0-8 小时，7.7 与 8.1；8-16 小时，4.4 与 8.0；16-24 小时 4.3 与 6.9）；在 8 至 16 小时时间点达到显著水平（P=0.006）。多模式、减少阿片类药物的镇痛方案可显著减少围手术期面部创伤管理中的阿片类药物使用，同时不牺牲患者满意的疼痛控制。
